The Benefit Summary for MEDICAID SIMP/OMB or MN cases is used to view the details of a selected Spousal Impoverishment budget. This view is similar to the paper DA4M budget form.
Begin Date: The budget month is displayed in the title bar of the window.
Program Case Group Box:
This box displays the first and last name of the Program Case Name person, the MEDICAID program type, the SIMP/OMB or MN category of MED eligibility, and the type of budget (regular or recalculated).
Budget Details Display Box:
Resource Total: This field displays the total amount of resources calculated for the program case.
Resource Limit: This field displays the resource limit established for the program case.
Comm Spouse Income Level: This field displays the income level for the community spouse.
Excess Shelter Allowance: This field displays the any excess shelter allowance (the shelter cost plus utility allowance minus the shelter limit.)
Family Memb Maint Need: This field displays the maintenance need for the dependent family members.
Total: This field displays the total of community spouse income level, excess shelter allowance, and family member maintenance need.
Comm Spouse Total Inc: This field displays the total earned and unearned income of the community spouse and dependent family members.
Actual Comm Spse/Fam Allow: This field displays the total need minus the income of the community spouse and dependent family members.
Unearned Income: This field displays the participant"s unearned income
Unearned Income Disregard: This field displays the unearned income disregard for the participant.
Net Unearned Income: This field displays the participant's unearned income minus any disregards.
Earned Income: This field displays the earned income of the participant.
Earned Income Disregard: This field displays the earned income disregard.
Net Earned Income: This field displays the countable earned income minus the disregard.
Resource Test: This field displays the Pass or Fail status of the resources.
Income Test: This field displays the Pass or Fail status of the income.
Unit Size: This field displays the number of eligible persons in the budget. Double click on this line to see the status of all persons in the case.
Total Net Countable Inc: This field displays the total of countable earned and unearned income.
Medical Income Level: This field displays the medical income level for the participant.
Share of Cost: This field displays the participant's share of cost based on the total countable income minus the medical income level.
Lower of Maximum or Actual Comm Spse/Fam Allow: This field displays either the Actual Community Spouse and Dependent Family Member allowance from the left side or the maximum allowance which ever is lower.
Adjusted Share of Cost: This field displays the Share of Cost minus any medical deductions and the Community Spouse and Dependent Family Member allowance.
Additional Excess Income: This field displays the Adjusted Share of Cost minus the medicaid nursing home per diem amount.
Private Pay Days: This field displays the number of days the participant must pay the nursing home at the private pay rate.
Creation Date: This field displays the date the budget was authorized.
Note: The specifics of many of the line items can be viewed by double clicking on the line. (designated on these pages in navy blue type). Budgets authorized before 07-06-2004 may be displayed in a different format and not all of the fields listed here in navy blue type will open.
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Select the OK button to close the Benefit Summary window. |
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Select the Help button for window specific Help information. |
NFO23
(07-2012)